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NPTE > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Which lung has 3 lobes? What are the fissures called?

A

a. Right lung

b. oblique and horizontal fissures

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2
Q

How many segments does the right lung have?

A

10 segments

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3
Q

How many segments does the left lung have?

A

8 segments

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4
Q

What pleura covers the inner surface of the thoracic cage, diaphragm, and mediastinal border of the lung?

A

parietal pleura

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5
Q

What pleura covers the outer surface of the lung including the fissure lines?

A

visceral pleura

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6
Q

definition

Potential space between the 2 pleurae that maintain the approximation of the rib cage and lungs allowing forces to be transmitted from one structure to another.

A

intrapleural space

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7
Q

What are the primary muscles of inspiration?

A
  1. diaphragm
  2. intercostals

Contraction: central tendon is pulled downward and flattens the diaphragm

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8
Q

What are the accessory muscles of inspiration?

A

Elevating ribs 1 and 2:
1. scalenes
2. SCM

Elevating other ribs
1. levator costarum
2. serratus

Note: if shoulder girdle is fixed the trapezius, pectorals, and serratus and become muscles of inspiration

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9
Q

When are expiratory muscles activated?

A

When a quicker and/or fuller expiration is desired

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10
Q

What are the expiratory muscles?

A
  1. QL
  2. intercostals
  3. abdominal muscles
  4. triangularis sterni
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11
Q

Those who lack adominal musculature have a (upper/lower) resting position of the diaphragm

A

Lower resting position

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12
Q

If a patient has a lower resting diaphragm, what does it do to inspiratory reserve?

A

decrease inspiratory reserve

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13
Q

The more upright the body position, the (lower/upper) the diaphragm is.

A

lower

+ lower inspiratory capacity

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14
Q

What is tidal volume?

A

Volume of gas inhaled during a normal breath

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15
Q

What is inspiratory reserve volume?

A

volume of gas that can be inhaled beyond a normal tidal inhalation

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16
Q

What is expiratory reserve volume?

A

volume of gas that can be exhaled beyond a normal tidal exhalation

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17
Q

What is residual volume?

A

volume of gas that remains in the lungs after expiratory reserve volume (ERV) has been exhaled

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18
Q

What is inspiratory capacity?

A

amount of air that can be inhaled from the resting end-expiratory position (REEP)

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19
Q

What is the formula for inspiratory capacity?

A

TV + IRV

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20
Q

What is vital capacity?

A

amount of air that is under volitional control

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21
Q

What is another name for vital capacity?

A

forced expiratory vital capacity (FVC)

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22
Q

What is the formula for vital capacity/forced expiratory vital capacity (FVC)?

A

TV + IRV + ERV

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23
Q

What is functional residual capacity?

A

amount of air that resides in the lungs after normal exhalation

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24
Q

What is the formula of functional residual capacity?

A

RV + ERV

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25
Q

What is total lung capacity?

A

total amount of air that is contained within the thorax during max. inspiration

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26
Q

What is the formula for total lung volume?

A

TV + IRV + ERV + RV

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27
Q

What is FEV1?

A

amount of air exhaled within first second of functional expirational capacity (FVC)

FVC: amount of air under volitional control (TV + IRV + ERV)

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28
Q

What is the normal FEV1 in a healthy person?

A

> 70%

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29
Q

What is forced expiratory flow rate (FEF)?

A

Slope of line between 25% and 75% of exhaled volume on a FVC exhalation curve.

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30
Q

What is forced expiratory flow rate more specific for?

A

More specific for smaller airways and shows a more dramatic change from disease

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30
Q

What are measures of ventilatory muscle strength? What are they used to determine?

A
  1. Maximal inspiratory pressure (MIP)
  2. Maximal expiratory pressure (MEP)

b. used as a guide for intubation and can be indicative of other disorders

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31
Q

What is the PaO2 at sea level?

A

159.6 mmHg

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32
Q

What is normal barometric pressure?

A

760 mmHg

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33
Q

What PaO2 is considered as mild hypoxemia?

A

< 80 mmHg

normal PaO2: 75-100 mmHg

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34
Q

What PaO2 is considered as hyperoxemia?

A

> 100 mmHg

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35
Q

(true/false) PaO2 decreases with age in healthy individuals

A

true

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36
Q

What is FiO2?

A

percentage of oxygen in the air based on a total of 1.0

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37
Q

What is the FiO2 of room air?

A

21%

(0.21)

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38
Q

A normal PaO2 of 90-100% translates to an SpO2 of what?

A

98-100%

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39
Q

At what pressure does oxygen dissociate more quickly from Hgb?

A

55-60 mmHg

corresponds to SpO2 of 88-90%

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40
Q

What is the normal range of PaCO2 within the arterial blood?

A

35-45 mmHg

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41
Q

What is the PaCO2 for hypercapnea?

A

> 45 mmHg

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42
Q

What is the PaCO2 of hypocapnea?

A

< 35 mmHg

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43
Q

What is the normal range of bicarbonate (HCO-3)?

A

22-28 mEq/L

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44
Q

An increase in bicarbonate leads to a (decrease/increase) of pH.

A

increases

direct relationship

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45
Q

An increase in PaCO2 leads to a (decrease/increase) of pH.

A

decrease

inverse relationship

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46
Q

When does optimal respiration occur?

A

When ventilation and perfusion are matched

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47
Q

What is dead space? Is it well ventilated?

A

Dead space is a space that is well ventilated but no gas exchange occurs within the space.

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48
Q

What are the two types of dead space?

A
  1. anatomical (conducting airways)
  2. physiological (diseases such as PE)
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49
Q

What is atelectasis? What is the cause?

A

a. collapsed or airless alveolar unit

b. hypoventilation secondary to pain in ventilatory cycle, internal bronchial obstruction, external bronchial compression, low TV, or neurologic insult

50
Q

definition

Complete atelectasis of the respiratory unit that allows the blood to travel through the pulmonary capillaries without gas diffusion

no respiration occurs due to pathology such as PNA, Pulmonary edema, or alveolar collapse

A

Shunt

51
Q

What is V/Q ratio?

A

ratio of pulmonary alveolar ventillation to pulmonary capillary perfusion

52
Q

What are the central control centers?

A
  1. cortex
  2. pons
  3. medulla
  4. ANS

sends a message to ventilatory muscles to alter respiratory cycle

53
Q

What medications can mask or alter vital signs?

A
  1. steroids (mask)
  2. beta blockers (alter)
  3. bronchodilators (alter)
54
Q

What is normal temperature (afebrile)?

A

98.6 degrees (37 degrees celsius)

55
Q

What are common sequelae to chronic lung disease?

A

Right ventricular hypertrophy and dilation (cor pulmonale)

56
Q

What is an acute sign of hypoxemia?

A

cyanosis to nails, around eyes, and around mouth

57
Q

What is digital clubbing a sign of?

A

chronic hypoxemia

bulbar distal phalanx of toes and fingers

58
Q

With obstructive pulmonary disease, the lung recoil force is (increased/decreased) resulting in what deformity?

A

a. decreased

b. results in barrel-chest (increased AP dimension)

59
Q

definition

soft rustling sound heard throughout all of inspiration and beginning of expiration

A

vesicular sounds (normal breath sound)

60
Q

definition

hollow, echoing sound during all of inspiration and most of expiration

A

bronchial breath sounds

61
Q

Where are bronchial sounds heard?

A

Right superior anterior thorax
(right main stem bronchus)

62
Q

definition

intermediate breath sound between bronchial and vesicular sounds with equal periods of inspiration and expiration

A

bronchovesicular sound

63
Q

When are decreased breath sounds commonly heard?

A

When obstructive lung diseases are present

  • allows only some of inspiration to be heard
  • not heard over healthy thorax
64
Q

What is the normal HR for an infant?

A

120 bpm

Adult: 60-100 bpm

65
Q

What is the normal BP for an infant?

A

75/50 mmHg

Adult: < 120/80

66
Q

What is the normal RR for infants?

A

40 br/min

Adult: 12-20 br/min

67
Q

What is the normal PaO2 for infants?

A

70-80 mmHg

Adult: 80-100 mmHg

68
Q

What is the normal PaCO2 for infants?

A

34-54 mmHg

Adult: 35-45 mmHg

69
Q

What is the normal pH for infants?

A

7.26-7.41

Adult: 7.35-7.45

70
Q

What is the regular tidal volume for infants?

A

20 ml

Adults: 500 ml

71
Q

When does crackling/rales/crepitations occur?

A

During inspiration

72
Q

definition

musically pitched sound caused by airway obstruction

A

wheezes

73
Q

When are wheezes heard?

A

during expiration

Severe airway constriction can lead to wheezing during inspiration

74
Q

Where does abnormal transmission of vocal sounds occur?

A

through fluid-filled areas of consolidation, cavitation lesions, and/or pleural effusion

75
Q

definition

nasal or bleating sound heard during auscultation – “E” sounds like “A”

A

egophony

76
Q

definition

characterized by intense, clear sound during auscultation

A

bronchophony

77
Q

definition

Occurs when whispered sounds are heard clearly during auscultation

A

whispered pectoriloquy

78
Q

What are the GXT test termination criteria?

(10)

A
  1. maximal SOB
  2. Fall of PaO2 by > 20 mmHg or a PaO2 less than 55 mmHg
  3. Increased PaCO2 by >10 mmHg or a PaCO2 greater than 65 mmHg
  4. cardiac ischemia or arrythmias
  5. s/s of fatigue
  6. increase of DBP by > 20 mmHg; systolic HTN >250 mmHg; decreased BP with increased workloads
  7. leg pain
  8. total fatigue
  9. signs of decreased cardiac output
  10. reaching ventilatory maximum
79
Q

Diagnosis

pH: increased
PaCO2: decreased
HCO3: WNL

A

respiratory alkalosis

80
Q

diagnosis

pH: decreased
PaCO2: increased
HCO3: WNL

A

respiratory acidosis

81
Q

diagnosis

pH: increased
PaCO2: WNL
HCO3: increased

A

metabolic alkalosis

82
Q

diagnosis

pH: decreased
PaCO2: WNL
HCO3: decreased

A

metabolic acidosis

83
Q

What is the cause of respiratory alkalosis?

A

alveolar hyerventilation

84
Q

What is the cause of respiratory acidosis?

A

alveolar hypoventilation

85
Q

What are the causes of metabolic alkalosis?

A
  1. HCO3 ingestion
  2. vomiting
  3. diuretics
  4. steroids
  5. adrenal disease
86
Q

What are causes of metabolic acidosis?

A
  1. Diabetic acidosis
  2. lactic acidosis
  3. uremic acidosis
  4. prolonged diarrhea
87
Q

What are the indications for postural drainge, percussion, and vibration?

A
  • atelectasis or collapse
  • increased secretions
  • aspiration
88
Q

What is the maximum amount of time for a postural drainage treatment?

A

20 minutes PER POSITION

89
Q

What is the maximum amount of time to perform percussion?

A

3-5 minutes PER POSITION

90
Q

What treatment technique is commonly used following percussion in the appropriate postural drainage position?

A

vibration

following a deep inhalation, vibration is applied during exhalation

91
Q

Why is percussion used in conjunction postural drainage?

A

To increase the amount of secretions cleared from the tracheobronchial tree

92
Q

How many vibration reps are most appropriate for secretion removal?

A

5-10

> 10 can cause hyperventilation
< 5 can be ineffective

93
Q

What should a patient do when sitting in the upright position between each lung area has been treated?

A

cough

94
Q

What airway clearance technique is more effective in patients with collapsible airways? Why?

A

a. huffing

b. prevents high intrathoracic pressure that causes premature airway closure

Deep inhalation followed by forced “Ha Ha”

95
Q

When is assisted coughing used?

A

When the patient’s abdominal muscles cannot generate an effective cough

96
Q

When is tracheal stimulation warranted during airway clearance techniques?

A

When the patient is unable to cough on demand

Thumb is placed on suprasternal notch and a quick inward and downward force is put onto the trachea

97
Q

What pressure should a suctioning system be set at when performing endotracheal suctioning for secretions?

A

120 mmHg

98
Q

What size of suction catheters should be used for adults?

A

14 french gauge

99
Q

What size of suction catheters should be used for older children?

A

10 french gauge

100
Q

What size of suction catheters should be used for children?

A

8 french gauge

101
Q

What size suction catheters should be used for infants?

A

5-6 french gauge

102
Q

What is the usual suctioning time?

A

10-15 seconds

103
Q

What are complications associated with suctioning?

A
  • hypoxemia
  • altered HR
  • altered BP
  • increased ICP
  • atelectasis
  • tracheal damage
  • infection
104
Q

What is autogenic drainage?

A

Program used to sense peripheral secretions and clear them without irritation from coughing

105
Q

What are the steps of autogenic drainage?

A
  1. unstick phase: quiet breathing at low lung volumes to affect peripheral secretions
  2. collect phase: breathing at mid-lung volumes to affect middle airway secretions
  3. evacuation phase: breathing from mid-high volumes to clear secretions from central airways
  4. repeat steps corresponding to the area of retained secretions
106
Q

Which phase of autogenic draining replaces coughing as a means to clear secretions?

A

evacuation phase

107
Q

What is a oscillatory positive expiratory pressure device (PEP)?

A

External device that vibrates the airways on exhalation to improve airway clearance with intermittent, positive expiratory pressure

108
Q

What is high frequency chest wall oscillation?

A

Pt wears a vest that fills with air and then rapidly increases/decreases pressure to loosen secretions

12-16 Hz (inflates until snug on patient’s chest)
duration: 20-30 mins

109
Q

(true/false) High frequency chest wall oscillation can be performed in postural drainage positions.

A

true

110
Q

What is diaphragmatic breathing used for?

A
  • Decrease work of breathing
  • facilitate relaxation
  • maintain or improve chest wall mobility
  • increase gas exchange and ventilation
111
Q

What is segmental breathing used for?

A
  • improve ventilation to hypoventilated lung segments
  • alters regional distribution of gas
  • maintain or restore functional residual capacity
  • maintain or improve chest wall mobility
  • prevention of pulmonary compromise
112
Q

What is the contraindication for segmental breathing?

A

contraindicated with intractable hypoventilation until medical stability

113
Q

What is sustained maximal inspiration used for?

A
  • increase inhaled volume
  • sustain or improve alveolar inflation
  • maintain or restore functional residual capacity
114
Q

Sustained maximal inspiration is used for (acute/chronic) cases

A

acute

115
Q

What training technique is used to load the muscles of inspiration by breathing through a series of graded aperture openings on a handheld device?

A

inspiratory muscle training (IMT)

116
Q

What cases will benefit from inspiratory muscle training?

A

Those with:
- decreased compliance
- decreased intrathoracic volume
- resistance to airflow
- alteration in length-tension relationship of ventilatory muscles
- decreased strength of respiratory muscles

117
Q

What breathing technique is used to spread out metabolic demands of activity over time by slowing its performance?

A

Paced breathing (activity breathing)

118
Q

What is the indication for use of paced breathing?

A

those who become dyspneic during exercise

119
Q

definition

removal of a lung

A

pneumonectomy

120
Q

definition

removal of a lung segment

A

segmental resection

121
Q

definition

removal of a lung lobe

A

lobectomy

122
Q

definition

removal of a portion of a lung without anatomical divisions

A

wedge resection

123
Q

definition

Removal of large emphysematous, nonfunctioning areas of the lung to normalize thoracic mobility and improve gas exchange of the remaining lung

A

lung volume reduction surgery (LVRS)

also called pneumectomy

NPTE (20 decks)

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